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MYUNG-SUP KIM MD PA
PO BOX 240
Cumberland, MD 21501
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Error Summary
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1. Patient Information
First Name
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M.I.
Last Name
*
Patient Account Number
Dates of Service Provided
Email Address
2. Payment Amount
Amount
3. Payment Method
Credit/Debit Card
Bank Account
Name on Card
*
Card Number
*
Expiration Date
*
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01
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YYYY
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2053
Security Code
*
Zip Code
*
Account Type
Checking
Savings
Routing Number
*
Account Number
*
Name On Check
Check Number
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